University of North Carolina at Chapel Hill, USA.
Soc Sci Med. 2022 Jul;305:115042. doi: 10.1016/j.socscimed.2022.115042. Epub 2022 May 20.
For many families whose children are placed in foster care, initial contact with the child welfare system occurs due to interactions with the healthcare system, particularly in the context of the opioid epidemic and increased attention to prenatal drug exposure. In the last decade, many previously uninsured families have gained Medicaid health coverage, which has implications for their access to healthcare services and visibility to mandatory reporters. Using administrative foster care case data from the Adoption and Foster Care Analysis and Reporting System Foster Care Files and health insurance data from the American Community Survey, this study analyzes the associations between state-level health insurance coverage and rates of foster care entry due to parental substance use between 2009 and 2019. State-level fixed effects models revealed that public, but not private, health insurance rates were positively associated with rates of foster care entry due to parental substance use. These results support the hypothesis that health insurance coverage may promote greater contact with mandatory reporters among low-income parents with substance use disorders. Furthermore, this study illustrates how healthcare policy may have unintended consequences for the child welfare system.
对于许多孩子被安置在寄养家庭的家庭来说，与儿童福利系统的最初接触是由于与医疗保健系统的互动，特别是在阿片类药物流行和对产前药物暴露的关注度增加的背景下。在过去十年中，许多以前没有医疗保险的家庭获得了医疗补助健康保险，这对他们获得医疗保健服务和强制报告者的可见性产生了影响。本研究利用收养和寄养分析和报告系统寄养档案中的行政寄养案例数据和美国社区调查中的健康保险数据，分析了 2009 年至 2019 年期间，州级健康保险覆盖范围与父母药物使用导致的寄养入院率之间的关联。州级固定效应模型表明，公共（而非私人）健康保险费率与父母药物使用导致的寄养入院率呈正相关。这些结果支持了这样一种假设，即健康保险覆盖范围可能会促进有药物使用障碍的低收入父母与强制报告者的更多接触。此外，本研究说明了医疗保健政策可能会对儿童福利系统产生意想不到的后果。
